Value of cerebroplacental and umbilical vein Doppler indices in prediction of perinatal outcome in prolonged pregnancy

Abstract

Introduction Prolonged pregnancy has commonly been used for pregnancies proceeding to or beyond 294 days of gestation, corresponding to 42 weeks+0 days. Fetal Doppler may help in their management, but previous studies have reported conflicting results. Aim To evaluate the value of middle cerebral artery (MCA) Doppler to umbilical artery (UA) Doppler ratio [cerebroplacental ratio (CPR)] and umbilical vein (UV) Doppler in predicting fetal compromise in uncomplicated prolonged pregnancies. Patients and methods This prospective observational study was held at Obstetrics and Gynecology Department, Al-Zahraa University Hospital, on 50 women with uncomplicated prolonged pregnancies beyond 40 weeks. The accuracy of UA, MCA, UV Doppler indices, and CPR in predicting of adverse outcomes had been calculated, the association between elevated CPR and UV pulsations and adverse perinatal outcome was also studied. Results MCA pulsatility index (PI) and CPR were significantly low among cases with meconium aspiration, respiratory distress, and neonatal intensive care unit (NICU) admissions, while UA-PI was significantly high. Regarding the diagnostic performances; CPR, MCA-PI, and MCA-RI were of high specificity in predicting cesarean delivery. Conclusion CPR had the highest significant diagnostic performance in predicting NICU admission; specificity and sensitivity of 94.6 and 69.2%, respectively, with a cut-off value=1.04. UA-PI had a significant diagnostic performance and characteristics in predicting NICU admission; specificity 91.9%, sensitivity 61.5%, and cut-off value=0.94. UV pulsation was detected in the cases with very poor neonatal outcomes.